My Toughest CaseTelling a Patient He Has Six Months to Live

Susan Lee, Internist, Stony Brook University Medical Center

One of my first patients at Stony Brook was a man I’ll call Mr. M. He was a retired schoolteacher in his late sixties who had moved from New Hampshire to be closer to his grandchildren. For ten years, Mr. M. and his wife would come in together. He would go in one room, and she would go in another. He would say, “Make sure she’s okay. I’m worried. She got a little dizzy. But don’t tell her I said that!” And then I’d have to say, “Have you been dizzy lately?” And she’d say, “Why are you asking?” And I’d say, “Oh, I don’t know. Just a routine question.”

Mr. M. was tall and dignified, positive and polite. He’d wear a coat and tie to come to the doctor. He had lots of children and grandchildren, and he’d tell me who had graduated from college and won awards and had gotten married. He’d bring pictures. He was an avid skier, and we’d talk about what mountains to try. He was a foodie, so we’d exchange restaurant recommendations. Medical students today don’t want to go into internal medicine because they don’t get paid well, but part of the reason I went into primary care is that I enjoy building that kind of relationship with a patient. People might see a specialist once or twice. Over the course of ten years, this gentleman had come to see me 40 or 50 times.

Mr. M. was a former smoker with emphysema and diabetes. One day he came to me with a prolonged cough and fever. I got a chest X-ray, and it looked like pneumonia, so I gave him antibiotics. But he wasn’t improving, so I ordered a CT scan. The results were devastating. He had a huge lung mass; he had maybe six months to live.

Because Mr. M. was my friend, telling him was especially difficult. It was a Friday evening when I got the report. I didn’t know what I was going to say. I spent the weekend going through the different scenarios. I’m going to be tough and just tell him that he has cancer. I’m going to play dumb and send him to the oncologist. On Monday morning, I called him and said, “Hey, Mr. M., it’s Dr. Lee. Have you got some time this morning? Bring your wife. I want to go over your CT scan with you.” And he said, “Is everything okay?” And I said, “Just come down to the office. We’ll go over it. I have some plans for you.”

In the exam room, Mr. M. and his wife were holding hands. I could tell by the look in their eyes that they knew it was bad. I said, “I got your CT scan back, and I think I know why your pneumonia is not getting better. It looks like you have lung cancer.” That’s all I said. And then I broke down and cried.

At that point, Mr. M. said, “Dr. Lee, you know what? You get an A-plus. Don’t worry, I’m going to be fine. We have the best doctor, and everything is going to be okay.” What patient ever says that? Then he and his wife were giving me hugs and asking me if I was all right.

Mr. M. ended up getting chemotherapy, radiation, and surgery. He became more and more frail, but his attitude was always positive. Never once did I hear him complain. He died at home. I still take care of his wife. The first time I saw her back in the office, she just looked at me and we cried. I think that day I didn’t even examine her. I just hugged her, and we talked about Mr. M. and how she was doing. I think that’s the best doctoring I could have done for her that day.